nutrients Article
Anemia and Micronutrient Status of Women of Childbearing Age and Children 6–59 Months in the Democratic Republic of the Congo Sarah Harvey-Leeson 1,† , Crystal D. Karakochuk 1,† , Meaghan Hawes 1 , Pierrot L. Tugirimana 2,3 , Esto Bahizire 4,5 , Pierre Z. Akilimali 6 , Kristina D. Michaux 1 , Larry D. Lynd 7 , Kyly C. Whitfield 1 , Mourad Moursi 8 , Erick Boy 8 , Jennifer Foley 1 , Judy McLean 1 , Lisa A. Houghton 9 , Rosalind S. Gibson 9 and Tim J. Green 1,10, * 1
2 3 4 5 6 7 8 9 10
* †
Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; [email protected] (S.H.-L.); [email protected] (C.D.K.); [email protected] (M.H.); [email protected] (K.D.M.); [email protected] (K.C.W.); [email protected] (J.F.); [email protected] (J.M.) Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo; [email protected] Department of Clinical Biology, College of Medicine and Heath Science, University of Rwanda, Kigali, Rwanda Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo; [email protected] Center of Research in Natural Sciences of Lwiro, Bukavu, Democratic Republic of the Congo Department of Nutrition, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; [email protected] Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; [email protected] International Food Policy Research Institute, Washington, DC 20006, USA; [email protected] (M.M.); [email protected] (Er.B.) Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; [email protected] (L.A.H.); [email protected] (R.S.G.) South Australian Health and Medical Research Institute, and the Women’s and Children’s Health Research Institute, Adelaide 5000, Australia Correspondence: [email protected]; Tel.: +61-88128-4000 These authors contributed equally to the data analysis and preparation of the manuscript.
Received: 7 January 2016; Accepted: 5 February 2016; Published: 17 February 2016
Abstract: Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK) and Kongo Central (KC). We determined hemoglobin (Hb), serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR), retinol binding protein (RBP), C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC), children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC), and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC), respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC), children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC), and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC). Regardless of indicator, iron deficiency anemia (IDA) never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP) deficiencies were all very low ( 5 mg/L), early convalescence (CRP > 5 mg/L and AGP > 1 g/L), and late convalescence (AGP > 1 g/L)) for ferritin are 0.77, 0.53 and 0.75 [24]; and for RBP are 1.13, 1.24 and 1.11 [25], respectively. Zinc was adjusted for inflammation using study-generated correction factors, which were determined with linear regression using the natural log of serum zinc concentration; and correction factors were calculated by 1 divided by the geometric mean ratio, according to the three stages of inflammation. The study-generated correction factors based on the three stages of inflammation for zinc were 1.01, 1.15 and 1.07 for children, and 1.07, 1.09 and 1.08 for women, respectively. Iron deficiency anemia (IDA) prevalence estimates were based on low Hb values that were adjusted for both altitude and ethnicity. IDA based on elevated sTfR (>8.3 mg/L) is indicative of tissue iron deficiency, whereas IDA based on low ferritin concentrations (
Anemia and Micronutrient Status of Women of Childbearing Age and Children 6–59 Months in the Democratic Republic of the Congo Sarah Harvey-Leeson 1,† , Crystal D. Karakochuk 1,† , Meaghan Hawes 1 , Pierrot L. Tugirimana 2,3 , Esto Bahizire 4,5 , Pierre Z. Akilimali 6 , Kristina D. Michaux 1 , Larry D. Lynd 7 , Kyly C. Whitfield 1 , Mourad Moursi 8 , Erick Boy 8 , Jennifer Foley 1 , Judy McLean 1 , Lisa A. Houghton 9 , Rosalind S. Gibson 9 and Tim J. Green 1,10, * 1
2 3 4 5 6 7 8 9 10
* †
Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; [email protected] (S.H.-L.); [email protected] (C.D.K.); [email protected] (M.H.); [email protected] (K.D.M.); [email protected] (K.C.W.); [email protected] (J.F.); [email protected] (J.M.) Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo; [email protected] Department of Clinical Biology, College of Medicine and Heath Science, University of Rwanda, Kigali, Rwanda Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo; [email protected] Center of Research in Natural Sciences of Lwiro, Bukavu, Democratic Republic of the Congo Department of Nutrition, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; [email protected] Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; [email protected] International Food Policy Research Institute, Washington, DC 20006, USA; [email protected] (M.M.); [email protected] (Er.B.) Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; [email protected] (L.A.H.); [email protected] (R.S.G.) South Australian Health and Medical Research Institute, and the Women’s and Children’s Health Research Institute, Adelaide 5000, Australia Correspondence: [email protected]; Tel.: +61-88128-4000 These authors contributed equally to the data analysis and preparation of the manuscript.
Received: 7 January 2016; Accepted: 5 February 2016; Published: 17 February 2016
Abstract: Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK) and Kongo Central (KC). We determined hemoglobin (Hb), serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR), retinol binding protein (RBP), C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC), children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC), and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC), respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC), children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC), and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC). Regardless of indicator, iron deficiency anemia (IDA) never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP) deficiencies were all very low ( 5 mg/L), early convalescence (CRP > 5 mg/L and AGP > 1 g/L), and late convalescence (AGP > 1 g/L)) for ferritin are 0.77, 0.53 and 0.75 [24]; and for RBP are 1.13, 1.24 and 1.11 [25], respectively. Zinc was adjusted for inflammation using study-generated correction factors, which were determined with linear regression using the natural log of serum zinc concentration; and correction factors were calculated by 1 divided by the geometric mean ratio, according to the three stages of inflammation. The study-generated correction factors based on the three stages of inflammation for zinc were 1.01, 1.15 and 1.07 for children, and 1.07, 1.09 and 1.08 for women, respectively. Iron deficiency anemia (IDA) prevalence estimates were based on low Hb values that were adjusted for both altitude and ethnicity. IDA based on elevated sTfR (>8.3 mg/L) is indicative of tissue iron deficiency, whereas IDA based on low ferritin concentrations (
